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Case study - National audit drives improvement in diabetes care

Find out about the work done by Kingston Hospital in 2017 that successfully improved the way they care for patients with diabetes.


The results of the March 2017 National Diabetes In-patient Audit (NaDIA) did not make for easy reading for staff at Kingston Hospital. The Trust was in the lowest quartile nationally for preventing harm and hypoglycaemic episodes.

Action was needed, and with the strong leadership and commitment from the executive team and a well-scoped Quality Improvement project (QIP), work began.

A systematic approach to improvement was undertaken. The multi-disciplinary project group was established and included representatives from teams including:

  • diabetes
  • the Acute Assessment Unit (AAU)
  • dietetics
  • podiatry
  • pharmacy
  • IT
  • clinical audit

It also included patient representation and our lead governor, who happens to be Chairman of the Kingston branch of Diabetes UK.

This energetic and dedicated multi-disciplinary team drove the success of the project by creating a shared sense of purpose and ownership, and effectively utilised influencers from across the Trust to help provide a nudge when changes stalled. 

The QIP used effective QI methodology and PDSA cycles to ensure progress was being made and reported into the Trust’s Quality Committee reporting structure to ensure visibility of progress to all.

Some initiatives that proved effective
  • Introduction of Diabetes Ward Champions - each link nurse is clearly identified by their champion badge
  • Implementation of an electronic referral process, sending referrals directly to the diabetes team for speedy and effective action
  • Extension of the MDT to enable better education to staff, including care for diabetic patients on enteral feeding
  • Raising the awareness of all staff about diabetes via Trust diabetes days, and participation in national initiatives, including Hypo Awareness Week and Insulin Safety Week
  • Newly branded high visibility hypoglycaemia boxes located on crash trollies
  • Flags for patients with diabetes on the electronic patient record to identify patients to the diabetes team
  • Magnetic badges on the patient’s bed as a visual aid to identify patients with diabetes
  • Carbohydrate mapping on the inpatient menu to help patients with the meal choices
  • Implemented the Ipswich Touch Test (foot assessment) to promote foot screening

2016 patient cohort - published Mar-17 2017 patient cohort - published Mar-17
Medication errors 51.6% Quarter 4 20.7% Quarter 1
Glucose management errors 45.2% Quarter 4 10.3% Quarter 1
Insulin errors 41.9% Quarter 4 10.3% Quarter 1
Mild hypoglycaemic episodes 28.9% Quarter 4 12.8% Quarter 1
Severe hypoglycaemic episodes 29.6% Quarter 4 0% Quarter 1

Next steps

The Trust aims to improve further by empowering patients to better manage their diabetes, reducing harms with the aim to be an exemplar organisation.  

Our next steps include:

  • the Diabetes Specialist Nurse and Joint Clinical Lead will sit on a panel of experts to advise on the future scope and development of NaDIA
  • a self-administration of insulin policy will be piloted on the AAU and rolled out across the Trust
  • improvement of peri-operative care - working with Diabetes UK and the London Clinical Network
  • root-cause analysis will be undertaken for all diabetic harms logged on the Trusts incident reporting system
  • the 6 steps to insulin safety e-learning package will be implemented as mandatory training for all clinical staff
  • automatic alerting of a hypoglycaemic episode to the diabetes team through EPR
  • to expand the diabetes team to include a dedicated inpatient diabetologist with in-patient podiatry and dietitian support
  • to become an exemplar organisation in foot assessment that others can learn from

Last edited: 1 December 2020 1:57 pm